Journal of Telemedicine and Telecare最新文献

The shortage of Allergy & Immunology providers in the United States restricts access to specialty care. Telemedicine has the potential to expand access beyond physical locations, however, little is known regarding patient preferences for tele-allergy or the ability to successfully manage atopic conditions virtually. This retrospective analysis of a tele-allergy program at the Veterans Health Administration demonstrates that tele-allergy can provide efficient allergy care for veterans, including rural patients, although some reliance on local ancillary services was necessary. A hybrid model of virtual and in-person care is likely needed in Allergy & Immunology to overcome geographical barriers and optimize resource allocation.

BackgroundThe Heart Health Hub (HHH) is a virtual model of care for patients with newly diagnosed heart failure. A program pilot commenced in April 2020 and aimed to achieve acceptable titration rates for heart failure medications while improving patient access to services. This study aimed to investigate whether the virtual HHH service could deliver feasible, safe and acceptable titration outcomes.MethodsA single-arm observational cohort study design was adopted. Eligible heart failure patients currently receiving care could consent to be enrolled in the pilot virtual HHH program based on pre-defined inclusion and exclusion criteria. Data on patient demographics, clinical characteristics and heart failure medication titration rates were obtained from routine health system databases and patient notes. Patient satisfaction data were collected using a Likert-scale questionnaire. Overall health service use and costs for each patient were obtained from health system databases for a period of 12 months following enrolment in the virtual HHH program.ResultsA total of 89 heart failure patients were included in the evaluation. Of these, 95% reached titration to either guideline-recommended target doses or maximum tolerated doses for both angiotensin-converting enzyme inhibitor/angiotensin receptor blockers/angiotensin and angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI) and beta-blockers combined. The mean number of days to achieve titration ranged from 20.2 days for mineralocorticoid receptor antagonist drugs, between 27.5 to 32.3 days for ACEI/ARB/ARNI drugs and 41.0 days for beta-blockers; 70 (79%) patients completed the satisfaction survey at least once, with more than 98% of survey questions receiving a positive response. The average monthly equipment and consumables cost per patient was $277 in year 2021/22.ConclusionThis study provides evidence that a virtual model of care for newly diagnosed heart failure patients was feasible, safe and acceptable, with high titration rates, relatively rapid times to titration, strong patient satisfaction outcomes and relatively low equipment costs.

IntroductionTrauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person.MethodsUsing data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth.ResultsIn our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans.DiscussionVideo telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

IntroductionOptimal hospital bed utilization requires innovative patient care models. We studied a novel hospitalist model utilizing telemedicine to facilitate collaboration with affiliated emergency departments (EDs) and support medical triage and care of ED patients with high likelihood of hospital admission.MethodsTelehospitalists based at a tertiary care facility collaborated with four community EDs in the same healthcare network between January 1, 2022, and April 30, 2023. Telehospitalists supported ED clinicians in medical care decisions and facilitated patient disposition. Emergency department length of stay (LOS) and disposition were evaluated, as were hospital LOS, 30-day readmission, and in-hospital mortality. For patients discharged from the ED, 7-day ED readmission and subsequent hospitalization were evaluated.ResultsTelehospitalists discussed 550 "admit-likely" patients with ED clinicians: 105 patients (19.1%) discharged from the ED and avoided admission; 322 patients (58.5%) were admitted to local or nearby community hospitals; 123 patients (22.4%) transferred to the tertiary care facility. Emergency department LOS differed significantly among disposition groups, including patients discharged home (10.2 h), admitted to local hospitals (12.6 h), and transferred to tertiary care hospitalist services (14.9 h; p < 0.001). Hospital LOS and in-hospital mortality were not significantly different among disposition groups. Patients admitted locally had lower 30-day readmission compared to those transferred to tertiary care facility (odds ratio = 0.59 [0.36, 0.99], p = 0.048).DiscussionTelehospitalists as triage clinicians is an innovative approach to support local ED clinicians and patients. Telehospitalists optimized hospital bed utilization and healthcare system resources by facilitating safe discharges to home and expediting tertiary care transfers when necessary.

BackgroundThe patient navigation programme (PNP) is an effective health intervention to address barriers in accessing timely and equitable cancer care. However, its expansion in Malaysia for breast cancer care faces challenges due to limited capacity building among nurses and navigators, particularly nurses who are actively involved in the operation of the PNP centres. The Extension for Community Healthcare Outcomes (ECHO^®) model, a tele-mentoring approach, offers a scalable and sustainable solution for capacity building among the nurses and navigators. This study aims to evaluate the feasibility and impact of using the ECHO model to train nurses and navigators on patient navigation competencies focused on improving breast cancer care delivery.MethodsThe study involved nurses in breast cancer care from Ministry of Health (MOH) state referral hospitals in Malaysia and newly recruited nurses and social workers by Cancer Research Malaysia to subsequently be placed as nurse and community navigator for the upcoming new centres. Participants received an ECHO-based training programme comprising bi-weekly virtual sessions of a six-domain curriculum covering 12 topics on patient navigation competencies. Pre- and post-session assessments were conducted to measure satisfaction, knowledge and confidence in conducting patient navigation.ResultsMost participants were within the age range of 31-35 (n = 38; 40.4% [95% CI, 30.5%-50.3%]) with majority being female (n = 87; 92.6% [95% CI, 87.2%-97.9%]) and MOH nurses (n = 71; 75.5% [95% CI, 66.8%-84.2%]). An average of 28 participants attended each session. Participants expressed high level satisfaction while showing improvements in knowledge and confidence with an average increase in mean score of (1.45 [95% CI, 0.84-2.13]; p < .05) and (0.61 [95% CI, 0.51-0.65]; p < .05) respectively following the intervention.ConclusionThe study demonstrates the feasibility and effectiveness of the ECHO model for patient navigation capacity building among nurses and navigators. Findings support broader implementation of the ECHO model to strengthen breast cancer care delivery.

IntroductionTelepsychiatry has been widely adopted following changes to the Medicare Benefits Schedule (MBS) telehealth policy. This study aimed to examine the effect of telehealth policy changes on the out-of-pocket costs of MBS-subsidised psychiatric consultations.MethodsWe extracted records of relevant face-to-face, video, and telephone consultations from linked MBS claims data, Pharmaceutical Benefits Schedule data (2017-2023) and the 2021 Census data. For each consultation mode, we calculated the average monthly bulk-billing rate and average fee gap for non-bulk-billed consultations. Multivariate regression analyses were conducted to examine the determinants of bulk-billing and the fee gap.ResultsIn total, 13,507,907 consultations involving 1,234,328 unique individuals were analysed. The average bulk-billing rate was 50.9%, decreasing over time. Fee gaps increased across all consultation modes. Face-to-face consultations were generally less likely to be bulk-billed and incurred higher fee gaps than other modes. Over successive policy periods, video consultations had an increasingly lower likelihood of bulk-billing and were associated with higher fee gaps. Patients in rural and remote areas were likely to bear greater out-of-pocket costs, including for video consultations. Attention Deficit Hyperactivity Disorder (ADHD) prescription-related consultations were associated with lower bulk-billing rates and higher fee gaps, especially in the video mode.DiscussionWhile the expansion of telepsychiatry increased service availability, it did not consistently reduce the financial burden of psychiatric care, especially for rural and remote Australians. The higher out-of-pocket costs associated with ADHD prescription-related consultations warrant closer policy attention.

IntroductionTelemedicine involves the use of electronic communication systems to exchange medical information between health professionals or with patients. With the increasing demand for telemedicine delivery, catalyzed by the COVID-19 pandemic, it is important to investigate the use of telemedicine within the field of hand surgery. The aim of this study is to present the current state of telemedicine use in hand trauma, with a particular focus on accuracy of diagnosis, cost effectiveness, and access to care.MethodsAn online systematic review of MEDLINE, EMBASE, Pubmed and The Cochrane Library from inception to 16 May 2025 was completed. Data extracted included telemedicine medium used, accuracy of diagnosis, cost, impact on patient transfer volume, and timeline for assessment. Study quality was assessed using the MINORS scale.ResultsOf the 15 included studies, eight assessed diagnostic accuracy, four evaluated cost savings, four examined patient transfers, five reported on efficiency, and three investigated access to care. All studies assessing accuracy found telemedicine to be an accurate method of triaging and diagnosing patients. All studies assessing cost-effectiveness found telemedicine to be an effective cost-savings instrument. Telemedicine was also demonstrated to improve healthcare efficiency by decreasing the number of unnecessary patient transfers, reducing extra visits and unnecessary consultations and improve access to specialist care for patients in rural communities.ConclusionsThe current literature suggests that the application of telemedicine in initial hand trauma consultation was found appears satisfactory diagnostic accuracy, cost savings, reduced patient transfers, increased efficiency, and improved access to care when compared to traditional face-to-face triaging and diagnosis of hand traumas although evidence is largely observational.

AimInvestigate the role of mobile stroke unit (MSU) and rendezvous transport with emergency medical service (EMS) in timely large vessel occlusion (LVO) identification and direct transfer to the comprehensive stroke center.MethodsThe fifth-generation MSU (5G-MSU) program was first implemented in 2019, directly dispatched through the 120 emergency medical services. The rendezvous transport was initiated in 2020. We report the first case of rendezvous transport plus prehospital computed tomography angiography (CTA) on 5G-MSU for endovascular treatment of LVO.ResultsA 5G-MSU was dispatched for a patient with reported right-sided hemiparesis and reduced consciousness at a primary stroke center, located at a distance of 106 km. The 5G-MSU and EMS coordinated a rendezvous transport to transfer the patient. CTA performed on the 5G-MSU revealed basilar artery occlusion, prompting immediate contact with the main hospital's angiography suite. Upon arrival, the patient was directly transferred to the angiography suite for endovascular therapy, achieving successful recanalization. Consequently, the call-to-puncture time was successfully achieved within 103 min, across a distance of 106 km.DiscussionRendezvous transport combined with prehospital CTA on the 5G-MSU in rural areas is feasible. This approach allows the MSU to extend beyond its conventional treatment coverage, rapidly identify large vessel occlusions, and thereby significantly reduce call-to-treatment time.

IntroductionTelemedicine has implemented the regional networks between 24/7 catheterization laboratories of "Hub" hospitals and the Territorial Emergency Medical Service (TEMS) to reduce time to diagnosis and treatment of ST segment elevation myocardial infarction (STEMI). Telemedicine has been conversely hypothesized to carry an excess of false-positive diagnoses; however, comparisons with a traditional diagnostic process at non-percutaneous coronary intervention capable ("Spoke") hospitals are lacking.MethodsThis multicenter case-control study retrospectively included 1001 consecutive patients with an initial diagnosis of STEMI or very high risk (VHR) non-ST elevation acute coronary syndrome who were referred from January 2018 to December 2021 to the Apulian STEMI network after an "in-presence" clinical evaluation at a Spoke center or a remote telemedicine-supported assessment. The comparative performance of both approaches has been evaluated by comparing the running diagnosis with the discharge diagnosis.ResultsTEMS and Spoke groups included 470 and 531 patients, respectively. False-positive diagnoses occurred in 21.3% and 35.8% of the TEMS and Spoke patients, respectively (p < 0.001). Spoke group showed a higher number of discharge diagnoses of non-ST elevation myocardial infarction without VHR features (p < 0.001), myocardial infarction with no obstruction of coronary arteries (p = 0.033), and myocarditis (p = 0.007). Overall, the main predictors of false-positive diagnoses were the referral from Spoke center, chronic kidney disease, and ongoing oral anticoagulation.ConclusionsTelemedicine showed lower false-positive rate compared with an on-site clinical cardiological assessment. This apparently paradoxical result questions the hypothesis of overdiagnosis as the main limitation of telemedicine which conversely reduces time-to-diagnosis and healthcare costs.

BackgroundForeign body aspiration (FBA) is a potentially fatal pediatric emergency, particularly in children under three years of age. Diagnostic delays are common in rural and resource-limited settings due to limited access to specialists, leading to increased morbidity. Telemedicine can play a critical role in early recognition and timely referral.Case PresentationWe report a 1.5-year-old boy from rural Haryana who developed a cough following almond ingestion. A teleconsultation was initiated via the eSanjeevani platform. On remote assessment, reduced air entry and wheeze on the left side raised suspicion of an airway foreign body. Chest X-ray revealed left lung hyperinflation with mediastinal shift. The child was urgently referred to a tertiary centre, where rigid bronchoscopy confirmed and successfully removed an almond from the left main bronchus. He recovered fully, with subsequent follow-up conducted via teleconsultation.DiscussionThis case highlights the value of telemedicine in early triage of pediatric FBA, especially in rural areas where bronchoscopy facilities are not immediately available. Prompt remote assessment facilitated timely diagnosis, urgent referral, and safe intervention, thereby preventing complications.ConclusionTele-triage through national platforms like eSanjeevani is a viable and effective strategy to bridge critical gaps in pediatric emergency care and improve outcomes in rural and resource-limited settings.